2022 ACC/AHA/HFSA Guideline for the Management of Heart Failure: Executive Summary

Heidenreich, Paul A.; Bozkurt, Biykem; Aguilar, David; Allen, Larry A.; BYUN, JONI-J.; Colvin, Monica; Deswal, Anita; Drazner, Mark H.; Dunlay, Shannon M.; Evers, Linda R.; Fang, James C.; Fedson, Savitri; Fonarow, Gregg C.; Hayek, Salim S.; Hernandez, Adrian F.; Khazanie, Prateeti; Kittleson, M.; LEE, CHRISTOPHER S.; Link, Mark S.; Milano, Carmelo A.; Nnacheta, Lorraine C.; Sandhu, Alexander T.; Stevenson, Lynne Warner; Vardeny, Orly; Vest, Amanda R.; Yancy, Clyde W.

doi:10.1016/j.cardfail.2022.02.009

Cited by 259 publications

(374 citation statements)

References 218 publications

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“…These are the million‐dollar questions. Although a multitude of editorials and viewpoints from the most experts in the HF field are insisting on a simultaneous approach, 9,10 contrary to the sequential development of all previous landmark trials, including the DAPA‐HF 11 and the EMPEROR‐Reduced 12 studies, the European and USA clinical practice guidelines 1,2 do not specify how clinicians should proceed. In the same line, the motto ‘as soon as possible’ is proclaimed based on the early benefit observed with SV and SGLT2i in HFrEF patients.…”

Section: Figurementioning

confidence: 99%

Sacubitril/valsartan adherence… because the best is sometimes difficult to replace the good

Álvarez‐García

2022

European J of Heart Fail

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Section: Figurementioning

confidence: 99%

Sacubitril/valsartan adherence… because the best is sometimes difficult to replace the good

Álvarez‐García

2022

European J of Heart Fail

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“…Dilated cardiomyopathy (DCM) is a common phenotype manifest in a diverse group of patients due to a combination of genetic and acquired susceptibility. Treatment includes pharmacological and device therapies for heart failure and uses left ventricular ejection fraction (LVEF) and New York Heart Association symptoms class (NYHA) as the main arbiters ( 1 ). The limitations of this approach, which fails to account for the vast heterogeneity in response to therapy and outcome are well recognized ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

“…The evidence to support genotype-guided risk stratification is growing ( 5 ) and targeted therapies for specific genotypes are on the horizon ( 6 , 7 ). Recommendations on the use of genetic testing for DCM differ between guidelines, likely due to a lack of evidence from which to draw consensus ( 1 , 8 – 10 ). The ACC/AHA/HFSA guidelines recommend targeted testing in patients with suspected inherited etiologies based on family history ( 1 ).…”

Section: Introductionmentioning

confidence: 99%

“…Recommendations on the use of genetic testing for DCM differ between guidelines, likely due to a lack of evidence from which to draw consensus ( 1 , 8 – 10 ). The ACC/AHA/HFSA guidelines recommend targeted testing in patients with suspected inherited etiologies based on family history ( 1 ). The ESC guidelines suggest routine use of genetic testing in all patients with DCM ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

“…As well as improving risk stratification for sudden cardiac death, the pattern of fibrosis and the presence of fibrofatty replacement may implicate certain genotypes or a prior inflammatory insult ( 12 ). However, it is not currently mandated for all patients within guidelines ( 1 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

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The addition of genetic testing and cardiovascular magnetic resonance to routine clinical data for stratification of etiology in dilated cardiomyopathy

Amin

Morris-Rosendahl²,

Edwards³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundGuidelines recommend genetic testing and cardiovascular magnetic resonance (CMR) for the investigation of dilated cardiomyopathy (DCM). However, the incremental value is unclear. We assessed the impact of these investigations in determining etiology.MethodsSixty consecutive patients referred with DCM and recruited to our hospital biobank were selected. Six independent experts determined the etiology of each phenotype in a step-wise manner based on (1) routine clinical data, (2) clinical and genetic data and (3) clinical, genetic and CMR data. They indicated their confidence (1-3) in the classification and any changes to management at each step.ResultsSix physicians adjudicated 60 cases. The addition of genetics and CMR resulted in 57 (15.8%) and 26 (7.2%) changes in the classification of etiology, including an increased number of genetic diagnoses and a reduction in idiopathic diagnoses. Diagnostic confidence improved at each step (p < 0.0005). The number of diagnoses made with low confidence reduced from 105 (29.2%) with routine clinical data to 71 (19.7%) following the addition of genetics and 37 (10.3%) with the addition of CMR. The addition of genetics and CMR led to 101 (28.1%) and 112 (31.1%) proposed changes to management, respectively. Interobserver variability showed moderate agreement with clinical data (κ = 0.44) which improved following the addition of genetics (κ = 0.65) and CMR (κ = 0.68).ConclusionWe demonstrate that genetics and CMR, frequently changed the classification of etiology in DCM, improved confidence and interobserver variability in determining the diagnosis and had an impact on proposed management.

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Association of Preexisting Heart Failure With Outcomes in Older Patients With Diffuse Large B-Cell Lymphoma

et al. 2023

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ImportanceAnthracycline-containing regimens are highly effective for diffuse large B-cell lymphoma (DLBCL); however, patients with preexisting heart failure (HF) may be less likely to receive anthracyclines and may be at higher risk of lymphoma mortality.ObjectiveTo assess the prevalence of preexisting HF in older patients with DLBCL and its association with treatment patterns and outcomes.Design, Setting, and ParticipantsThis longitudinal cohort study used data from the Surveillance, Epidemiology, and End Results (SEER)–Medicare registry from 1999 to 2016. The SEER registry is a system of population-based cancer registries, capturing more than 25% of the US population. Linkage to Medicare offers additional information from billing claims. This study included individuals 65 years and older with newly diagnosed DLBCL from 2000 to 2015 with Medicare Part A or B continuously in the year prior to lymphoma diagnosis. Data were analyzed from September 2020 to December 2022.ExposuresPreexisting HF in the year prior to DLBCL diagnosis ascertained from billing codes required one of the following: (1) 1 primary inpatient discharge diagnosis, (2) 2 outpatient diagnoses, (3) 3 secondary inpatient discharge diagnoses, (4) 3 emergency department diagnoses, or (5) 2 secondary inpatient discharge diagnoses plus 1 outpatient diagnosis.Main Outcomes and MeasuresThe primary outcome was anthracycline-based treatment. The secondary outcomes were (1) cardioprotective medications and (2) cause-specific mortality. The associations between preexisting HF and cancer treatment were estimated using multivariable logistic regression. The associations between preexisting HF and cause-specific mortality were evaluated using cause-specific Cox proportional hazards models with adjustment for comorbidities and cancer treatment.ResultsOf 30 728 included patients with DLBCL, 15 474 (50.4%) were female, and the mean (SD) age was 77.8 (7.2) years. Preexisting HF at lymphoma diagnosis was present in 4266 patients (13.9%). Patients with preexisting HF were less likely to be treated with an anthracycline (odds ratio, 0.55; 95% CI, 0.49-0.61). Among patients with preexisting HF who received an anthracycline, dexrazoxane or liposomal doxorubicin were used in 78 of 1119 patients (7.0%). One-year lymphoma mortality was 41.8% (95% CI, 40.5-43.2) with preexisting HF and 29.6% (95% CI, 29.0%-30.1%) without preexisting HF. Preexisting HF was associated with higher lymphoma mortality in models adjusting for baseline and time-varying treatment factors (hazard ratio, 1.24; 95% CI, 1.18-1.31).Conclusions and RelevanceIn this study, preexisting HF in patients with newly diagnosed DLBCL was common and was associated with lower use of anthracyclines and lower use of any chemotherapy. Trials are needed for this high-risk population.

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2022 ACC/AHA/HFSA Guideline for the Management of Heart Failure: Executive Summary

Cited by 259 publications

References 218 publications

Sacubitril/valsartan adherence… because the best is sometimes difficult to replace the good

Sacubitril/valsartan adherence… because the best is sometimes difficult to replace the good

The addition of genetic testing and cardiovascular magnetic resonance to routine clinical data for stratification of etiology in dilated cardiomyopathy

Association of Preexisting Heart Failure With Outcomes in Older Patients With Diffuse Large B-Cell Lymphoma

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